AIDS: China’s titanic threat

NEW YORK — The recent warning by the Chinese government that HIV/AIDS is spreading rapidly in the country and that new and urgent measures are needed to combat the infection marks an important step in the fight against HIV/AIDS. This is particularly remarkable because, at the beginning of the epidemic, Chinese authorities were reluctant to admit the extent of the problem. China must sustain the political will and combine strategies to deal with the infection.

According to Chinese government estimates, 840,000 people in China are HIV carriers, 80,000 have tested positive for AIDS and 100,000 are believed to have died of the disease. Experts believe that these numbers underestimate the extent of the problem and warn that China could have as many as 10 million AIDS patients in 2010 if the efforts to curb the infection are not adequate.

During the 1990s, HIV/AIDS was considered a “foreign problem” in China, and most Chinese considered the infection totally removed from their daily lives. According to a survey carried out by the State Family Planning Commission, 70 percent of HIV-infected people in 2000 lived in the countryside. Among those, 23 percent had never heard of AIDS.

The Chinese government states that most infected people belong to three main groups: intravenous drug users, commercial sex workers and recipients of contaminated blood. It is estimated that, in central Henan Province alone, more than 1 million people contracted HIV from selling blood in unsanitary collection stations. Although Henan constitutes the best-known case, 22 other provinces, including SARS-affected Shanxi in the north, have also what is known as “AIDS villages,” where the infection is most widespread.

Although the Chinese government has adopted a much more combative attitude toward the infection, its efforts are still hindered by poor baseline data necessary for properly assessing the problem and allocating resources. The problem is compounded by the fact that, in traditional Chinese culture, sex and sexuality are not openly spoken about. Many young people lack information on sexually transmitted diseases and on the modes of HIV transmission. According to the U.S. Centers for Disease Control, only 10 percent of Chinese who have HIV/AIDS know that they are infected.

Rapid economic growth has led to a dramatic increase in migration of workers from the rural areas to the main cities, away from their families and communities. Migrant workers are much more prone than others to visit sex workers, thus increasing their possibility of becoming HIV infected. Many people are unaware of the need for condom use, particularly with commercial sex partners, to avoid getting infected.

What is now needed are massive education campaigns for which the Chinese are particularly effective. For example, the literacy campaign in the 1950s was one of the most successful ever carried out anywhere. These campaigns should target not only students but also high-risk groups such as drug users and sex workers.

At the same time that prevention measures are stressed, those infected should have easier and cheaper access to treatment. According to John Chen, an independent researcher based in Hong Kong, the HIV/AIDS situation in China justifies compulsory licensing of AIDS drugs by the government so that cheaper versions of the drug can be produced and sold at lower costs in the country. That kind of licensing is permitted under Article 31 of the Trade Related Intellectual Property Rights agreement.

China is experiencing a “national emergency” of titanic proportions. The monthly cost of treatment is more than $350 — well beyond the means of most people affected by HIV/AIDS.

An alternative approach would be to reach an agreement with pharmaceutical companies in India or Brazil, which are already producing generic AIDS drugs at much lower cost than international drug companies. China needs to act now, and fast.